Favorável de infecção por SARS-COV-2 em paciente com insuficiência hipofisária

Background: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) outbreak originated in Wuhan (China) rapidly turned into a pandemic. Due to a national compulsive decree of quarantine, office visits for chronic disease control were delay.Hypopituitarism includes all clinical conditions that result in partial or complete failure of the pituitary gland's ability to secrete hormones. Pituitary insufficiency per sehas been associated with an increase in both morbidity and mortality, particularly due tocardiovascular disease, which is an important risk factor for COVID-19 disease severity. Objective: To report the first case of SARS-CoV-2 infection in a patient with hypopituitarism, discuss the implications of the treatments the patient was taking and grade up the value of telemedicine in the present scenario. Methods: Report of the clinical record of a patient with hypopituitarism and infection with SARS-CoV-2. Results: During the span of the infection, the patient remained on the same hormonal therapeutic scheme (thyroid, gonadal and adrenal axis). The dose of hydrocortisone was not changed during the course of the infection as she was asymptomatic. We use telemedicine to control and advise her on the treatment. Conclusion: Health care professionals should carefully follow up on the evolution of patients with hypopituitarism to provide them a safer outcome. The use of telemedicine as a methodology for selected patients acquires relevance in the present epidemiological context.Introducción: El nuevo coronavirus 2 del Síndrome Respiratorio Agudo Grave (SARS-CoV-2), la cepa viral que está causando la enfermedad pandémica conocida como COVID-19, está generando un desafío sin precedentes para los sistemas de salud de todo el mundo. Dicho escenario puede favorecer el deterioro de las patologías crónicas por la dificultad en el acceso al sistema sanitario. El hipopituitarismo es una condición clínica que se asocia a comorbilidades desfavorables en la evolución de la infección por coronavirus. Objetivo: reportar el primer caso de infección por SARS-CoV-2 en una paciente con hipopituitarismo. Métodos: se describe el primer caso de una mujer con insuficiencia hipofisaria e infección por SARS-CoV-2. Se destaca el aporte de la telemedicina como estrategia para seguir al paciente en forma remota. Resultados: la paciente permaneció con el mismo esquema de terapia de reemplazo hormonal (eje tiroideo, gonadal y adrenal). Se implementó la telemedicina para asesorar sobre la adaptación del tratamiento. Debido a que cursó el proceso infeccioso en forma asintomática no se modificó la dosis de hidrocortisona, evidenciando una evolución favorable. Conclusiones: los profesionales de la salud deben permanecer atentos y vigilar la evolución de los pacientes con insuficiencia hipofisaria e infección por SARS-CoV-2. El uso de la telemedicina, en pacientes seleccionados, se jerarquiza en el contexto epidemiológico actual.Introdução: O novo coronavírus 2 da Síndrome Respiratória Aguda Grave (SARS-CoV-2), a cepa viral que está causando a doença pandêmica conhecida como COVID-19, está criando um desafio sem precedentes para os sistemas de saúde em todo o mundo. Esse cenário pode favorecer o agravamento das patologias crônicas devido à dificuldade de acesso ao sistema de saúde. O hipopituitarismo é uma condição clínica associada a comorbidades desfavoráveis na evolução da infecção por coronavírus. Objetivo:relatar o primeiro caso de infecção por SARS-CoV-2 em paciente com hipopituitarismo. Métodos: é descrito o primeiro caso de uma mulher com insuficiência hipofisária e infecção por SARS-CoV-2. A contribuição da telemedicina é destacada como estratégia para acompanhar o paciente à distância. Resultados: a paciente permaneceu com o mesmo esquema de terapia de reposição hormonal (eixo tireoidiano, gonadal e adrenal). A telemedicina foi implantada para orientar sobre a adaptação do tratamento. Devido ao processo infeccioso assintomático, a dose de hidrocortisona não foi modificada, apresentando evoluçãofavorável. Conclusões: os profissionais de saúde devem permanecer vigilantes e acompanhar a evolução dos pacientes com insuficiência hipofisária e infecção por SARS-CoV-2. O uso da telemedicina, em pacientes selecionados, é hierárquico no contexto epidemiológico atual.publishedVersionFil: Fux Otta, Carolina. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas; Argentina.Fil: Moreno, Laura. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas; Argentina.Fil: Vitaloni, Roberto. Dirección de Epidemiología del Departamento Castellanos de la Provincia de Santa Fe; Argentina.Fil: Iraci, Gabriel S. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas; Argentina

The Distance to the Galactic Center Derived From Infrared Photometry of Bulge Red Clump Stars

On the basis of the near infrared observations of bulge red clump stars near the Galactic center, we have determined the galactocentric distance to be R_0 = 7.52 +- 0.10 (stat) +- 0.35 (sys) kpc. We observed the red clump stars at |l| < 1.0 deg and 0.7 deg < |b| < 1.0 deg with the IRSF 1.4 m telescope and the SIRIUS camera in the H and Ks bands. After extinction and population corrections, we obtained (m - M)_0 = 14.38 +- 0.03 (stat) +- 0.10 (sys). The statistical error is dominated by the uncertainty of the intrinsic local red clump stars' luminosity. The systematic error is estimated to be +- 0.10 including uncertainties in extinction and population correction, zero-point of photometry, and the fitting of the luminosity function of the red clump stars. Our result, R_0 = 7.52 kpc, is in excellent agreement with the distance determined geometrically with the star orbiting the massive black hole in the Galactic center. The recent result based on the spatial distribution of globular clusters is also consistent with our result. In addition, our study exhibits that the distance determination to the Galactic center with the red clump stars, even if the error of the population correction is taken into account, can achieve an uncertainty of about 5%, which is almost the same level as that in recent geometrical determinations.Comment: 14 pages, 4 figures, accepted by Ap

Multiplicity of nuclear dust lanes and dust lane shocks in the Milky Way bar

Aims: We show the existence of a small family of inner-galaxy dust lanes and dust lane standing shocks beyond the two major ones that were previously known to exist Methods: We analyze images of CO emission in the inner regions of the Galaxy Results: The peculiar kinematics of the major dust lane features are repeated in several other distinct instances at l > 0deg, in one case at a contrary location 100 pc above the galactic equator at l > 3degr at the upper extremity of Clump 2. Like the previously-known dust lanes, these new examples are alsoassociated with localized, exceptionally broad line profiles believed to be characteristic of the shredding of neutral gas at the standing dust lane shocks. Conclusions: There may be secondary dust lane and standing shocks in the Milky Way bulge. The vertical structure provides a temporal sequence for understanding the secular evolution of gas flow in the bar

A method for comparing discrete kinematic data and N-body simulations

This paper describes a method for quantitatively comparing an N-body model with a sample of discrete kinematic data. The comparison has two stages: (i) finding the optimum scaling and orientation of the model relative to the data; and (ii) calculating a goodness of fit, and hence assessing the plausibility of the model in vew of the data. The method derives from considering the data and model both as samples from some underlying binned distribution function, and applying probability theory arguments. As an example, I consider a published N-body model for the Galactic bulge and disc, and fictitious l,b,v measurements, and recover (with error estimates) the spatial and velocity scales of the model and the orientation of the bar. The fictitious data are actually derived from the model by assuming the mass scale and the solar position, but their size and extent mimics a recent survey of OH/IR stars. The results indicate that mass of the bulge and our viewing angle of the bar are usefully estimable from current surveys.Comment: To appear in A

Kinematics of the Galactic Globular Cluster System: New Radial Velocities for Clusters in the Direction of the Inner Galaxy

HIRES on the Keck I telescope has been used to measure the first radial velocities for stars belonging to eleven, heavily-reddened globular clusters in the direction of the inner Galaxy. The question of kinematic substructuring among the Galactic globular cluster system is investigated using an updated catalog of globular cluster distances, metallicities and velocities. It is found that the population of metal-rich globular clusters shows significant rotation at all Galactocentric radii. For the metal-rich clusters within 4 kpc of the Galactic center, the measured rotation velocity and line-of-sight velocity dispersion are similar to those of bulge field stars. We investigate claims that the metal-rich clusters are associated with the central Galactic bar by comparing the kinematics of the innermost clusters to that of the atomic hydrogen in the inner Galaxy. The longitude-velocity diagram of both metal-rich and metal-poor clusters bears a remarkable similarity to that of the gas, including the same non-circular motions which have traditionally been interpreted as evidence for a Galactic bar, or, alternatively, a non-axisymmetric bulge. However, uncertainties in the existing three-dimensional Galactocentric positions for most of the clusters do not yet allow an unambiguous discrimination between the competing scenarios of membership in a rigidly rotating bar, or in a bulge which is an oblate isotropic rotator. We conclude that the majority of metal-rich clusters within the central 4 kpc of the Galaxy are probably associated with the bulge/bar, and not the thick disk. (ABRIDGED)Comment: 18 pages, including 7 of 13 postscript figures. Figures 1-6 available at http://astro.caltech.edu/~pc. Accepted for publication in the Astronomical Journa

HIV-Infektion : Update 2009 für Hausärzte. Teil 1

Quintessenz: In der Schweiz werden jährlich >750 HIV-Infektionen neu diagnostiziert. Die Ansteckung geschieht via Blut oder Sex, und nicht bei alltäglichen sozialen Kontakten. Die CD4-Lymphozytenzahl ist bestens etabliert zur Messung der Immunsuppression. Die grösste Gefahr opportunistischer Infekte droht bei CD4-Werten <200/μl. Dank antiretroviraler Therapie (ART) sollten viele HIV-infizierte Patienten in der Schweiz eine quasi normale Lebenserwartung haben. Momentan ist eine ART bei CD4-Werten <350/μl indiziert. Die HIV-Diagnose wird auch in der Schweiz häufig zu spät gestellt. Hausärzte spielen bei der frühzeitigen Diagnosestellung (grosszügiges Anbieten von HIV-Tests) und bei der Prävention von Immundefizienz und opportunistischen Komplikationen eine entscheidende Rolle. P Bei HIV-Neudiagnose soll der Patient einem HIV-Spezialisten zugewiesen werden, um weitere Abklärungen durchzuführen und die Indikation zum ART-Beginn zu stellen

An inner ring and the micro lensing toward the Bulge

All current Bulge-Disk models for the inner Galaxy fall short of reproducing self-consistently the observed micro-lensing optical depth by a factor of two ($> 2\sigma$). We show that the least mass-consuming way to increase the optical depth is to add density roughly half-way the observer and the highest micro-lensing-source density. We present evidence for the existence of such a density structure in the Galaxy: an inner ring, a standard feature of barred galaxies. Judging from data on similar rings in external galaxies, an inner ring can contribute more than 50% of a pure Bulge-Disk model to the micro-lensing optical depth. We may thus eliminate the need for a small viewing angle of the Bar. The influence of an inner ring on the event-duration distribution, for realistic viewing angles, would be to increase the fraction of long-duration events toward Baade's window. The longest events are expected toward the negative-longitude tangent point at $\ell\sim$ -22\degr . A properly sampled event-duration distribution toward this tangent point would provide essential information about viewing angle and elongation of the over-all density distribution in the inner Galaxy.Comment: 9 pages, 7(15) figs, LaTeX, AJ (accepted

Haemodialysis activates phospholipase A2 enzyme

Background Clinical and experimental evidence suggest that haemodialysis (HD) procedure is an inflammatory process. For the production of proinflammatory lipid mediators in many inflammatory reactions, the release of arachidonic acid by phospholipase A2 (PLA2 enzyme is a prerequisite. Therefore, the purpose of the present investigation was to establish whether the activity of PLA2 increases during HD and whether the increase depends on the type of dialyser used. Methods We performed dialysis in eight chronic HD patients. Blood samples entering and leaving the dialyser were obtained before and at 15, 60, 120 and 180 min after the dialysis was started, on one occasion using a cuprophane and on another occasion a cellulose triacetate dialyser. PLA2 activity was assessed in crude plasma and in plasma extract. Results PLA2 activity in plasma extract exhibited similar biochemical properties to that of inflammatory human synovial fluid PLA2 enzyme which is of group II PLA2. PLA2 activity in crude plasma represents a type of PLA2 other than the synovial type. In HD patients, baseline PLA2 activities in crude plasma and plasma extract were significantly increased when compared to normal subjects. An increase in PLA2 activity was observed in crude plasma with a peak appearing at 15 min when the patients were dialysed with cuprophane and cellulose triacetate membranes. This increase was observed in both arterial and venous blood samples and was more pronounced when the patients were dialysed with cuprophane than with cellulose triacetate membranes. When PLA2 was assessed in plasma extract, the activity increased only with cuprophane but not with cellulose triacetate membranes. Conclusions PLA2 activity in plasma is increased in HD patients and increases during the dialysis procedure to a greater extent with a less biocompatible membrane. Continuous activation of PLA2 might be relevant for long-term deleterious consequences of H

Viral Load and Cell Tropism During Early Latent Equid Herpesvirus 1 Infection Differ Over Time in Lymphoid and Neural Tissue Samples From Experimentally Infected Horses

Upper respiratory tract infections with Equid Herpesvirus 1 (EHV-1) typically result in a peripheral blood mononuclear cell-associated viremia, which can lead to vasculopathy in the central nervous system. Primary EHV-1 infection also likely establishes latency in trigeminal ganglia (TG) via retrograde axonal transport and in respiratory tract-associated lymphatic tissue. However, latency establishment and reactivation are poorly understood. To characterize the pathogenesis of EHV-1 latency establishment and maintenance, two separate groups of yearling horses were experimentally infected intranasally with EHV-1, strain Ab4, and euthanized 30 days post infection (dpi), (n = 9) and 70 dpi (n = 6). During necropsy, TG, sympathetic trunk (ST), retropharyngeal and mesenteric lymph nodes (RLn, MesLn) and kidney samples were collected. Viral DNA was detected by quantitative PCR (qPCR) in TG, ST, RLn, and MesLn samples in horses 30 and 70 dpi. The number of positive TG, RLn and MesLn samples was reduced when comparing horses 30 and 70 dpi and the viral copy number in TG and RLn significantly declined from 30 to 70 dpi. EHV-1 late gene glycoprotein B reverse transcriptase PCR and IHC results for viral protein were consistently negative, thus lytic replication was excluded in the present study. Mild inflammation could be detected in all neural tissue samples and inflammatory infiltrates mainly consisted of CD3+ T-lymphocytes (T-cells), frequently localized in close proximity to neuronal cell bodies. To identify latently infected cell types, in situ hybridization (ISH, RNAScope®) detecting viral DNA was used on selected qPCR- positive neural tissue sections. In ganglia 30 dpi, EHV-1 ISH signal was located in the neurons of TG and ST, but also in non-neuronal support or interstitial cells surrounding the neuron. In contrast, distinct EHV-1 signal could only be observed in neurons of TG 70 dpi. Overall, detection of latent EHV-1 in abdominal tissue samples and non-neuronal cell localization suggests, that EHV-1 uses T-cells during viremia as alternative route toward latency locations in addition to retrograde neuronal transport. We therefore hypothesize that EHV-1 follows the same latency pathways as its close relative human pathogen Varicella Zoster Virus